Dissertations / Theses on the topic 'Hemiplegia Rehabilitation'

Objective: gait of patients after stroke. Stroke is acute vascular disturbance in the brain, which involves sensory and motor systems of the opposite side to the brain lesion. Inability to walk or abnormal gait pattern is one of the biggest problem after cerebral vascular accident, which predispose the stoke survivors to a sedentary lifestyle, which further limits the individual’s activities of daily living and reduces cardiovascular reserves. One of the primary goals for physical therapy is to restore the ability to walk. It is the first step in becoming independent. In this case the main purposes of this study – to evaluate the influence of the physical therapy of gait of stoke patients. The tasks to reach the purpose of this study were: 1) to assess the effectiveness of special active walking exercises in order to regain the gait; 2) to assess the effectiveness of balance exercises in order to regain the gait; 3) to compare the effectiveness of different physiotherapy methods. The study was performed in physical medicine and rehabilitation department of Virsuziglis rehabilitation hospital. Thirty patients after cerebral vascular stoke, took part in this study. They were divided in two groups. The first group’s patients besides the traditional physical therapy performed special active walking exercises. The second group’s patients additionally were applied balance exercises. These used research methods: “Up and Go” test, Berg balance scale, motor assessment scale, Smidt... [to full text]

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009.
Introduction Decreased hip extension in the paretic leg is a common impairment after stroke. Gluteal taping was introduced as a technique that helped in increasing hip extension of the paretic leg, and step length in the unaffected leg. The aim of this study was to further investigate the effect of gluteal taping on other temporal spatial and kinematic parameters using a 3D motion analysis system (Moven System). Methods The study was conducted in two phases. Phase 1 entailed examining the intra trial reliability of the Moven System, where eight subjects were recruited and tested twice at their normal pace of walking, and twice again at their maximum speed. Phase 2 involved studying the effect of gluteal taping on temporal spatial and kinematic parameters. Thirty subjects participated and were tested under three taping conditions (no tape, therapeutic tape, and placebo tape), while walking at their self selected walking speed. Intra-class correlation coefficient ICC determined around 95% confidence intervals was used to examine the intra trial reliability of the Moven System. Repeated measures-ANOVA was used to study the temporal spatial, and kinematic variables during the three taping conditions. Results The Moven showed moderate to excellent reliability in measuring the gait variables including temporal spatial parameters and sagittal kinematic parameters in addition to the lateral pelvic tilt. Taping caused significant increase in hip extension and reduction in knee flexion at terminal stance for the paretic leg. There was a trend toward better hip flexion at terminal stance, and a mild trend toward more planter flexion at terminal stance. Both treatment and placebo tapes caused an increase in the step lengths of either leg, and a significant increase in gait velocity and cadence. Conclusion Gluteal taping may be beneficial in producing important clinical effects post stroke, and can be used as an adjunct strategy during gait rehabilitation. Further research is needed to understand the mechanism of how taping produces effects, and to further explore its effect on kinetic and muscle activation variables.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009.
The ability to walk has been rated by stroke patients as one of the most important goals of their rehabilitation. Knee control is a key element in normal gait. Currently, treatment options aimed at improving poor knee control in stroke patients are often costly, need specialised equipment and have poor patient compliance. The purpose of the current study was to assess whether medial patellar taping could improve knee control in stroke patients. Gait speed, dynamic standing balance, knee alignment and whether the subjects experienced any subjective stabilising effect on the knee after taping were tested. Twenty subjects diagnosed with hemiplegia after a stroke served as their own controls in a repeated measures experimental study. Results indicated that dynamic standing balance as tested by the Step Test (p=0.063) and the Timed-up-and-go test (p=0.099) (Wilcoxon test) showed marginal improvement after taping. This improvement in dynamic standing balance may indicate that neuro-motor control and/or eccentric knee control had improved. There was no change in walking speed and knee alignment as tested by change in the Q-angle (Wilcoxon test). However, a decrease in the Q-angle correlated with an improvement in dynamic standing balance as tested by the Step Test (p=0.029) (Spearman‟s test). Participants with decreased Q-angles after taping possibly had better knee alignment and were more willing to accept weight on their affected leg indicating a change in quadriceps activation. No change in walking speed (p=0.351) (Wilcoxon test) before and after taping may indicate that there was no change in the magnitude of contraction and/or concentric activity in the quadriceps muscle. Thirty percent of the participants reported a subjective change in knee stability after taping. Subjective change did not, however, significantly correlate with either of the balance tests, walking speed or Q-angle measurements. The possibility that medial patellar taping may be useful in treating poor knee control in stroke patients during dynamic balance activities should be investigated further.

INTRODUÇÃO: A perda óssea acelerada é uma das reconhecidas complicações da hemiplegia pós-acidente vascular encefálico (AVE), mas pouco se sabe sobre o ritmo de perda na fase crônica e seus determinantes. O objetivo deste estudo foi avaliar a evolução tardia da densidade mineral óssea (DMO) em pacientes hemiplégicos crônicos, bem como identificar possíveis fatores associados. MÉTODOS: Foi realizado um estudo longitudinal envolvendo pacientes ambulatoriais com hemiplegia há mais de 12 meses. Pacientes com doenças e outras condições associadas à perda óssea foram excluídos. Avaliações clínica e densitométrica foram realizadas no início e após aproximadamente 16 meses, e foram analisados fatores de risco para perda óssea. RESULTADOS: Cinquenta e sete pacientes foram estudados, sendo 40 do sexo masculino, com média de 59,3 anos e tempo médio de hemiplegia de 33,4 meses. Ao comparar os hemicorpos acometido e não acometido, foi observada perda óssea mais acentuada em antebraço acometido (p=0,001), mas não em fêmur acometido. Foi observada perda óssea significativa em 56% dos pacientes em antebraço e 22,6% em fêmur, no lado acometido. Maior tempo de AVE foi protetor para a perda óssea em antebraço (OR = 0,96, IC 95%: 0,92 0,99; p=0,015), e o uso de anticoagulantes e/ou anticonvulsivantes (OR = 5,83, IC 95%:1,25 27,3; p=0,025) e espasticidade moderada/intensa (OR = 8,29, IC 95%:1,10 62,4; p=0,040) foram determinantes para perda óssea em fêmur. CONCLUSÕES: O presente estudo evidenciou que a perda óssea é comum e frequente em antebraço acometido em pacientes com hemiplegia crônica, com tendência à estabilização da perda com o passar do tempo. Espasticidade mais intensa e uso de anticoagulantes e/ou anticonvulsivantes foram associados à perda óssea em fêmur. Estes achados indicam que pacientes hemiplégicos crônicos devem ser monitorados e tratados para perda óssea, com atenção para os determinantes identificados, e que o membro superior acometido deve ser incluído na avaliação da DMO
INTRODUCTION: Accelerated bone loss is a well-known early complication of hemiplegia. However, less is known about chronicphase bone loss and its determinants. The objective of this study was to evaluate long-term changes in bone mineral density (BMD) in chronic hemiplegic patients, and investigate possible related factors. METHODS: A longitudinal study involving chronic stroke-related hemiplegic patients was conducted. Clinical and densitometric evaluations were performed at baseline and after approximately 16 months, and risk factors for bone loss were analyzed. RESULTS: Fiftyseven patients were studied (40 males) with a mean of 59.3 years and with mean time since hemiplegia of 33.4 months. Decrease in BMD was more pronounced in affected forearms compared to the nonaffected forearms (p=0.001). No difference was found between affected and non-affected femurs. Bone loss was observed in 56% of the affected forearms and 22.6% of the affected femurs. Longer time since stroke was protective for bone loss in the forearm (OR = 0.96, 95% CI: 0.92 0.99; p=0.015), and the use of anticoagulation/antiepileptic drugs (OR = 5.83, 95% CI: 1.25 27.3; p=0.025) and moderate/severe spasticity (OR = 8.29, 95% CI: 1.10 62.4; p=0.040) were associated to bone loss in the femur. CONCLUSIONS: Bone loss is common and more frequent in the affected forearm in chronic hemiplegic patients with tendency to stabilize over time. Greater spasticity and use of anticoagulation and/or antiepileptic drugs were proved to be associated with bone loss at the femur. Our findings indicate that chronic hemiplegic patients should be monitored and treated for bone loss, with attention to the identified determinants, and that the upper paretic limb should be included in BMD evaluation

Orientador: Antônio Augusto Fasolo Quevedo
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação
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Resumo: Indivíduos acometidos por acidente vascular encefálico (AVE) freqüentemente apresentam diminuição na habilidade de controlar os movimentos do ombro, cotovelo e punho, bem como de realizar as tarefas de preensão com o membro superior afetado (parético). Na última década, estudos têm investigado os efeitos da aplicação simultânea e intensiva de estimulação elétrica neuromuscular e exercícios funcionais, como forma de auxiliar na reabilitação dos movimentos da mão. Uma vez comprovada a efetividade deste procedimento terapêutico, denominado Terapia Elétrica Funcional Intensiva (TEFI), poderá haver aplicação em larga escala nos centros de reabilitação, devido à redução do tempo de tratamento proporcionado pelo procedimento, uma vez que este consiste, essencialmente, em oferecer aos pacientes sessões de tratamento longas e várias vezes por semana, porém, por poucas semanas. Convencionalmente, os pacientes se submetem a duas ou três sessões de cinqüenta minutos de fisioterapia por semana, durante anos. Contudo, várias questões no que se refere à combinação destas duas técnicas terapêuticas ainda estão por serem respondidas. O objetivo do presente estudo foi comparar os efeitos do treinamento funcional isolado com os efeitos do treinamento funcional somado à terapia elétrica funcional intensiva, a curto, médio e longo prazo, na função motora do membro superior acometido por paresia decorrente de AVE. Dez voluntários, com média de idade e de tempo de lesão de 63,1 (±11) anos e 7,9 (±6,8) meses, respectivamente, foram selecionados e divididos por sorteio em dois grupos. Oito voluntários concluíram o estudo. A intervenção foi de 5 semanas, 30 minutos de terapia convencional somados a 30 minutos de TEFI. Para o grupo experimental foi utilizado estimulador elétrico neuromuscular de 4 canais, marca Actigrip® CS system. Nas primeiras duas semanas de tratamento com estimulação elétrica, apenas músculos proximais do membro superior (m. deltóide, fibras anteriores e laterais) foram estimulados via eletrodo de superfície, com pulso monofásico com carga compensada, freqüência de 50 Hz, tempo de pulso de 200 µs e amplitude de 20 a 45 mA. Nas três semanas seguintes, o mesmo procedimento foi aplicado a músculos distais do membro superior. (canal 1 - extensor longo do polegar e, canal 2- m. oponente e flexor do polegar, canal 3 - flexor profundo em superficial dos dedos e canal 4 - músculo extensor comum dos dedos). A eletroestimulação foi realizada de tal forma a recrutar estes grupos musculares numa seqüência que mimetizava o movimento de pegar e soltar um objeto, qual seja, de estender sequencialmente o polegar, os dedos e punho e, na seqüência, flexionar o polegar, os dedos e punho. A função motora foi avaliada através dos seguintes testes: 1) Teste de Funcionalidade para Membros Superiores (Upper Extremity Functioning Test -UEFT), 2) Teste do quadrado adaptado (Drawing Test- DT) e avaliação neurológica. A análise de variância (ANOVA) mostrou diferença significante (F(4,20)=8,4; p<0,01) para o parâmetro número de repetições de movimentos funcionais realizados em dois minutos. O teste post hoc - Tukey Honest Significant Difference mostrou que tanto o grupo TEFI quanto o grupo controle apresentaram aumento significante na média do número de repetições no TFMS do pré-terapia para 2 e 5 semanas de tratamento, bem como 12 e 24 semanas de acompanhamento (p<0,03). O número de repetições das tarefas motoras aumentou de aproximadamente 8 para 11 repetições em dois minutos. Conclusão: o treinamento funcional do membro superior acometido por paresia, decorrente de AVE, somado ou não a terapia elétrica funcional intensiva induziu à melhora na funcionalidade motora. Este resultado foi atingido nas primeiras 2 semanas de treinamento e se manteve por um período de 24 semanas.
Abstract: Stroke results with decreased ability to control shoulder and elbow movements, as well as compromised grasping. In the last decade, researchers have investigated the effect of simultaneously applied intensive neuromuscular electrical stimulation and functional exercises, aiming rehabilitation of hand movements. Once proved to be effective, Intensive Functional Electrical Therapy (IFET) tends to be widely used in rehabilitation centers due to decreased treatment time needed for each patient. Conventionally, patients attend to two or three fifty minutes physiotherapy sessions a week for years. However, many questions concerned the combination of these two therapeutic techniques is still to be addressed. The present study aimed to compare the effect of functional therapy with functional therapy plus IFET, in short, medium, and in a long term. Ten volunteers, with mean (±SD) age and after stroke time 63.1 (±11) and 7.9 (±6.8) weeks and months, respectively, were randomly selected and divided in two groups. Eight volunteers concluded the study. Volunteers underwent to 5 weeks of treatment, composed of 30 minutes of conventional therapy in addition to 30 minutes of IFET. For the experimental group, a four channel electrical stimulator Actigrip® CS system was used. In the first two weeks of treatment using electrical stimulation, only upper limb proximal muscles were stimulated (m. deltoid - anterior and lateral fibers), with surface electrodes, using a 200 ?s, 50 Hz, compensated monophasic pulse, 20-45 mA of intensity. In the following three weeks, the same procedure was applied to distal upper limb muscles (channel 1 - extensor pollicis longus m., channel 2 - flexor pollicis and opponens m., channel 3 -flexor digitorum profundus and superficialis m. e channel 4 - extensor communis digitorum m.). Electrical stimulation was applied in such a way to facilitate the volunteers to grip objects, which means to extend the thumb fingers and wrist, grasp the object and then to flex the thumb, fingers and wrist. Motor function was evaluated using the Upper Extremity Functioning Test - UEFT), Drawing Test- DT, and neurological evaluation. Analysis of variance (ANOVA) showed significant difference (F(4,20)=8,4; p<0,01) for the parameter number of functional task repetitions. The Tukey Honest Significant Difference test showed that both, TEFI and control groups significantly increased the number of motor task repetitions they could perform in two minutes(p<0,03). This was significant when pre-treatment was compared with post-treatment (2 and 5 weeks of treatment, and 12 and 24 weeks of follow-up). The number of times the volunteers performed the motor task increased from 8 to approximately 11. In conclusion, functional training of upper limb, impaired due to stroke, whether added or not to intensive electrical stimulation improved motor function. This result was obtained after two weeks of treatment and last for a period of 24 weeks.
Mestrado
Engenharia Biomedica
Mestre em Engenharia Elétrica

El ictus sigue siendo la principal causa de discapacidad motora en el mundo, y la hemiparesia contralateral a la lesión, el síntoma más común. La afectación del miembro superior va a condicionar de forma notable la funcionalidad del brazo, su incorporación en actividades de la vida diaria, y la calidad de vida del paciente. Mejorar el control sensitivo-motor del miembro superior es uno de los retos importantes en neurorrehabilitación La neurorehabilitación se basa en el hecho de que los principios de aprendizaje motor se pueden aplicar a la recuperación de movimiento tras una lesión cerebral, y que el entrenamiento puede desembocar en mejorías permanentes en la función sensitivo-motora. En base a los conocimientos sobre control motor, aprendizaje y plasticidad tras ictus, se deben establecer programas terapéuticos que fomenten la neuroplasticidad adaptativa. El objetivo principal de la Tesis es recoger y analizar los resultados protocolos de rehabilitación destinados a la recuperación del miembro superior parético en sujetos crónicos. Como parte del cuerpo principal de la tesis se incluyen dos estudios: - Effect of a mixed reality-based intervention on arm, hand and finger function on chronic stroke: Evalúa un protocolo apoyado en un Entorno de Realidad Mixta diseñado para sujetos hemiparéticos con afectación leve - Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial: Estudia la eficacia de un protocolo de Terapia con Espejo, aplicado a sujetos con afectación muy severa En el apartado Anexo se incluye otro trabajo publicado: - Eficacia del sistema Armeo®Spring en la fase crónica del ictus. Estudio en hemiparesias leves-moderadas: Refleja la eficacia de la asistencia robótica, destinado en este caso al abordaje de brazo con una afectación leve-moderada. Por otra parte, se revisa la literatura científica a través de las bases de datos Medline, PubMed, EMBASE y PEDro, al respecto de las técnicas de rehabilitación estudiadas, su eficacia y los fundamentos fisiológicos en las que se basan. Con el entorno de Realidad Mixta en sujetos con paresia leve, y con la terapia con sistema Robótico para pacientes con afectación leve-moderada del miembro superior, se objetivan beneficios significativos en escalas pertenecientes al dominio CIF de actividad. En el primer caso también hay cambios positivos significativos en las de participación, y en el segundo, en las escalas de función. El estudio controlado de Terapia con Espejo para el miembro superior con afectación sensitivo-motora muy severa resulta en beneficios significativos en la sensibilidad táctil, mientras que la mejoría a nivel motor no alcanza significación estadística.
Stroke is still the main cause of motor disability in the world, and hemiparesis is the most common symptom after stroke. Involvement of the upper limb is going to significantly affect the arm function, the participation in basic daily tasks, and the quality of life of the patients. Improving motor control of the upper limb is an important challenge in neuro-rehabilitacion. Neuro-rehabilitation is based on the fact that motor learning principles can be applied to movement recovery after brain injury, and that training can lead to permanent improvements in motor and sensitivity function. Based on the knowledge of motor control concepts, learning principles and plasticity after stroke, we must establish therapeutic programs that enhance adaptive brain reorganization changes. The main objective of the thesis is to analyze the results of different rehabilitation protocols designed for the recovery of the paretic upper limb in chronic patients. Two studies are included in the main body of the thesis: -Effect of a mixed reality-based intervention on arm, hand and finger function on chronic stroke: it evaluates the effect of using a specific mixed reality environment in a rehabilitation program designed for hemiparetic subjects with mild upper limb paresis. - Mirror therapy in chronic stroke survivors with severely impaired upper limb function: to randomized controlled trial: it studies the effectiveness of a mirror therapy rehabilitation protocol on hemiparetic subject with severe motor and sensitive arm impairment. A third published essay regarding upper limb rehabilitation is included in the Annex: - Efficacy of Armeo®Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis: it evaluates the effectiveness of robotic assistance approach, for patients with a mild to moderate paresis. Moreover, the thesis includes a thorough review of scientific publications regarding the rehabilitation techniques mentioned, using Medline, PubMed, EMBASE and PEDro databases. The mixed-reality system in subjects with a mild upper limb paresis, and the robotic system for patients with mild to moderate arm impairment, reflects statistically significant improvements in assessment scales belonging to the activity ICF domain. In the first case, we observe improvements also in participation scales , and in the second case, in function scales. The controlled mirror therapy protocol addressed to patients with very severe motor and sensitive arm impairment, results in significant benefits in touch sensitivity, while motor improvements don´t reach statistical significance.

Chez la personne atteinte d'hémiplégie, la restauration des capacités posturales est considérée comme un des objectifs majeurs du processus de réhabilitation. Aujourd'hui, les grandes caractéristiques de la posture érigée chez le patient hémiplégique sont bien connues. Cependant, un certain nombre d'interrogations, relatives à la nature des mécanismes déficitaires et au type de rééducation à développer, subsiste. Au cours de ce travail doctoral, nous avons utilisé les concepts et les outils de l'approche dynamique des systèmes sensori-moteurs pour étudier les déficits posturaux de cette population. Dans ce cadre, ces déficits sont assimilés aux anomalies spatio-temporelles observables dans les coordinations hanche/cheville. Dans un premier temps, nous avons cherché à quantifier la nature des modifications de la dynamique posturale consécutives à une lésion cérébrale. Nous avons étudié, d'une part, la dynamique spontanée lors d'une tâche de poursuite de cible, et d'autre part, la dynamique intentionnelle en présence d'une information comportementale spécifiant la coordination à produire. A travers ces deux expérimentations, une disparition de l'attracteur en phase et une diminution de la stabilité de l'attracteur en anti-phase ont pu être mises en évidence. Dans un second temps, sur la base de ces résultats, nous avons proposé un (ré)apprentissage des deux modes de coordination préférentiels à l'aide d'un dispositif de biofeedback. L'objectif était de déterminer si la restauration d'une dynamique posturale dite "normale" était possible en dépit de la pathologie. Les résultats montrent un (ré)apprentissage du patron en phase suite au protocole; (ré)apprentissage qui s'accompagne d'une amélioration du niveau d'indépendance fonctionnelle des patients. Dans leur ensemble, ces résultats contribuent à une plus grande compréhension des déficits posturaux du patient hémiplégique et proposent des pistes de réflexion intéressantes pour la mise en place de futurs protocoles de rééducation
The improvement of postural capacities is regarded as one of the major goals of rehabilitation of hemiplegic patients. Today, the main characteristics of the upright posture are well-known. However, many questions concerning the nature of affected mechanics and possible physical therapies remain open. In this work, we studied postural deficits in a hemiplegic population following the concepts and tools of the dynamical approach of sensori-motor systems. Deficits were considered as spatio-temporal anomalies of the organization of the postural system and analyzed through ankle/hip coordination patterns. First, we investigated modifications of postural dynamics following stroke in two different experiments. We observed both spontaneous dynamics during a tracking task and intentional dynamics using behavioral information specifing the to be produced coordination pattern. Results of both studies showed disappearance of the in-phase pattern and less stable performance in the anti-phase pattern. Second, based on gained knowledge, we proposed a (re)learning task of the two preferred postural patterns using a biofeedback design. The aim was to assess the success of this protocol for the recovery of "normal" dynamics and to explore the effect of this (re)learning on postural and functional abilities. Results suggested that the recovery of the in-phase pattern is possible and seemed to improve independence of patients. Summarized, this work proposes a new way to investigate postural deficits in post-stroke population and provided a base for the development of new therapies

Orientador: Antonio Augusto Fasolo Quevedo
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Eletrica e de Computação
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Resumo: Objetivo: verificar o efeito da adição da Estimulação Elétrica Neuromuscular (NMES) ao treinamento do padrão de Facilitação Neuromuscular Proprioceptiva (FNP) em membro superior de pacientes hemiparéticos pós-AVC. Metodologia: foram selecionados 10 pacientes, divididos igualmente em dois grupos. Ambos receberam o treinamento com os padrões de FNP, entretanto o grupo 2 recebeu a adição da NMES. As avaliações dos membros superiores foram realizadas pré-tratamento (iniciais), pós-tratamento (finais) e após 7 a 8 semanas do término das sessões de tratamento (tardias). Para a avaliação utilizou-se a Escala de Fugl-Meyer, o índice de Barthel Modificado (IBM) e Escala de Ashworth. Resultados: Análises não-paramétricas revelaram aumentos estatisticamente significativos na pontuação motora total do MS em todos os estágios da avaliação de Fugl-Meyer para o grupo 1. O grupo 2 somente mostrou aumento estatisticamente significativo para o estágio I x F (p-valor=O,O30), sendo para os demais estágios o p-valor>O,O5. Na escala de Ashworth encontrou-se diferença significativa somente entre a comparação dedo I dedo F do grupo 1 (p-valor=O,O30). No grupo 1, encontraram-se diferenças significativas (pvalor=O,O30) na goniometria ativa e passiva da flexão de ombro e de cotovelo I x F e I x T, e também houve diferença significativa na flexão de punho passiva F x T e extensão de punho passiva I x T. Não houve diferença estatisticamente significativa no IBM para ambos os grupos. Conclusões: analisando-se isoladamente cada grupo, o protocolo utilizado para o grupo de FNP foi suficiente para aumentar a pontuação motora do MS na Escala de Fugl-Meyer, apresentando retenção do tratamento. Entretanto a adição da NMES não foi suficiente para garantir a retenção do tratamento e alterar o IBM e Escala de Ashworth
Abstract: Objectives: The aim of this study was to evaluate the efficacy of Neuromuscular Electrical stimulation (NMES) added to Proprioceptive Neuromuscular Facilitation (PNF) patterns in upper limbs of hemiparetic patients after stroke. Methods: Ten hemiparetic subjects were divided into two groups, both receiving PNF patterns. Group 2 received, in addition, NMES. Upper limb was evaluated pre-treatment (initial - I), post-treatment (final - F) and after 7 or 8 weeks after the end of the sessions (Iate - L). Motor function was assessed with the upper extremity motor subscore of the Fugl-Meyer Assessment (FMA), the Modified Barthel lndex (MBI), and Ashworth Scale for muscular tonus. Results: Non-parametric analyses revealed statistically significant gains in Fugl-Meyer Scores between I x F, I x L and F x L (p=O,O30) in group 1. Group 2 only showed statistically significant gains for I x F, for the other combinations p>O,O5. Ashworth Score presented significant differences only for fingers I x F in group 1 (p=O,OO3). For group 1, there were significant differences (p=O,OO3) in active and passive goniometry for shoulder flexion I x F and I x L, elbow flexion I x F and Initial x L, and there were also significant differences in passive wrist flexion F x L and passive wrist extension I x L. There were not statistically significant differences in MBI for both groups. Conclusion: The methodology was able to increase the motor score of upper extremity by Fugl-Meyer Score and increasing amplitude of the passive and active movement. Meanwhile, the addition of FES was not enough to change with statistical significance the data of the Fugl-Meyer Assessment, MBI and Ashworth Scale
Mestrado
Engenharia Biomedica
Mestre em Engenharia Elétrica

O objetivo deste estudo foi avaliar o efeito do biofeedback (BIO) associado à terapia ocupacional (TO) e à estimulação elétrica funcional (FES) na espasticidade, movimento ativo e função do membro superior de pacientes hemiplégicos. Este estudo foi realizado na Divisão de Medicina de Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Cinqüenta e nove pacientes acometidos por acidente vascular cerebral participaram do estudo por um ano; 31 receberam TO+FES duas vezes por semana + BIO uma vez por semana e 28 receberam somente TO+FES duas vezes por semana. Os pacientes foram avaliados inicialmente, após 6 meses e após 1 ano através da Avaliação da Função Manual, do Teste de Destreza Manual Minnesota, do Teste de Amplitude de Movimento e da Escala de Ashworth modificada. TO+FES+BIO melhoraram significativamente a amplitude de movimento e função dos membros superiores após 6 meses e 12 meses, quando comparado com somente TO+FES. Ambos os grupos melhoraram significativamente a espasticidade, após 6 meses e 12 meses, com diferença não significante entre eles. O uso adicional do biofeedback mostrou efeito positivo em amplitude de movimento e recuperação da função do membro superior no grupo estudado e pode representar uma importante ferramenta para a reabiltação de pacientes hemiplégicos
The objective of this was to study the effect of biofeedback (BIO) associated to occupational therapy (OT) and functional electrical stimulation (FES) on spasticity, range of motion and upper extremity function of hemiplegic patients. The study took part at the Division of Rehabilitation Medicine of the Hospital das Clínicas of the University of São Paulo School of Medicine. Fifty-nine stroke patients were studied for one year; 31 received OT+FES twice a week + BIO once-a-week and 28 received only OT+FES twice-aweek. The patients were evaluated initially, after six months and after one year with the use of Manual Function Evaluation, Minnesota Manual Dexterity Test, Range of Joint Motion Test and Modified Ashworth Scale. OT+FES+BIO significantly improved range of motion and upper extremity function after 6 months and 12 months, compared to only OT+FES. Both groups showed significant improvement of spasticity, after 6 months and 12 months, with no significant difference between them. The additional use of BIO had a positive effect in range of motion and function recovery of upper extremity in the studied group and may represent an important therapeutic tool for stroke rehabilitation

BACKGROUND: il dolore alla spalla in seguito all’emiplegia è una conseguenza clinica comune dell'ictus. Esso può manifestarsi dopo due settimane dall'evento lesivo, ma anche a distanza di due o tre mesi. Può influire negativamente su tutti gli esiti della riabilitazione, in quanto una buona funzionalità della spalla è un prerequisito fondamentale per i trasferimenti, per il mantenimento dell'equilibrio, per l’efficienza della mano e per lo svolgimento delle attività della vita quotidiana. OBIETTIVI: lo scopo di questa revisione è ricercare evidenze in letteratura sull’utilizzo del tape elastico per controllare il dolore nella spalla del soggetto emiplegico e verificarne l’efficacia e la correttezza di utilizzo. METODI DI RICERCA: sono state consultate le banche dati elettroniche CENTRAL, PEDro e Pubmed. La ricerca è iniziata nel Febbraio 2019 ed è conclusa nell’Ottobre 2019. Sono stati inclusi solo Randomized Controlled Trials inerenti il soggetto emiplegico con dolore alla spalla trattato utilizzando il tape elastico in associazione ad una riabilitazione standard. RISULTATI: sono stati individuati 4 RCT. Le misure di outcome prese in esame sono concerni a: dolore, range di movimento passivo o attivo, entità delle sublussazioni, grado di spasticità, lesioni dei tessuti molli, attività muscolare e funzione. CONCLUSIONI: trattare un soggetto in presenza di “hemiplegic shoulder pain” con tape elastico può essere un metodo sicuro ed efficace se associato ad un’adeguata riabilitazione convenzionale. L’applicazione, in aggiunta ad una riabilitazione standard, oltre ad incidere positivamente sul sintomo primario, il dolore, può far decrescere tutti i fattori secondari causanti complicanze (ROM limitato, entità delle sublussazioni, degenerazione tendinea, grado di spasticità e attività muscolare ridotta). Inoltre, può incrementare la sua funzione, comportando un miglioramento del soggetto nelle attività e una miglior qualità della vita.

Cerebral palsy is a non-progressive disorder associated with brain injury, defect, or disease, of early onset. Emphasis is placed on the more easily observable motor deficits, with any underlying sensory deficits often being overlooked. Existing sensory assessments have either been standardized on an adult population or for a paediatric population without significant neuromotor impairment. Thus, there is a need to formulate a standardized sensory assessment battery that may be used to evaluate physically handicapped children. A review of the literature highlights the necessity to evaluate the presence and extent or sensory dysfunction in school-age hemiplegic children, using a standardized clinical sensory assessment battery, as well as somatosensory evoked potentials.
A reliable sensory battery, which assesses 5 sensory modalities, was formulated and normative data for school-age children was derived. Sensory function was evaluated in 9 hemiplegic children (4-19 years) and 18 healthy age-matched controls. Significant bilateral sensory deficits were documented in hemiplegic children. Thus a sensory assessment should be an integral part of the evaluation of a child with hemiplegia.

Background: L’80% delle persone colpite da ictus cerebrale riporta una compromissione dell’arto superiore che persiste nel 60% dei casi a sei mesi dall’evento acuto. Negli ultimi anni stanno aumentando le evidenze sull'applicazione della terapia robotica. Questa rispetta infatti i principi neurofisiologici dell’apprendimento motorio, sebbene non sia ancora chiara la corretta modalità di associazione con la terapia tradizionale. Obiettivo: Indagare la letteratura riguardo l’efficacia della riabilitazione robotica associata alla fisioterapia tradizionale sul recupero della funzionalità dell’arto superiore in soggetti con ictus. Metodi: Sono state consultate le banche dati Pubmed, PEDro e CENTRAL. È stato definito il PICOS: P: Soggetti adulti con primo episodio di ictus, esiti di emiplegia unilaterale e compromissione della funzionalità dell’arto superiore; I: Riabilitazione robotica associata a fisioterapia tradizionale; C: Fisioterapia tradizionale isolata; O: Funzionalità dell’arto superiore; S: RCT. La ricerca è stata limitata alle pubblicazioni tra il 2011 e il 2021, con full-text in italiano o inglese, reperibili tramite il servizio proxy o contattando direttamente l’autore. Risultati: Sono stati inclusi cinque RCT. Sebbene gli outcome fossero conformi all’obiettivo, la tipologia dello strumento robotico e le modalità di intervento non erano omogenei. Tuttavia, quattro studi hanno dimostrato la superiorità dell'intervento sperimentale e uno studio ha riportato un’uguaglianza tra i due interventi. Conclusione: Nonostante l’eterogeneità dell’intervento applicato e delle fasi riabilitative non renda generalizzabili i risultati, la terapia robotica si è rivelata efficace nell’incremento della funzionalità dell’arto superiore in soggetti con ictus. Sono necessari approfondimenti per individuare la fase e la dose adeguate a poter delineare un protocollo specifico di integrazione tra terapia robotica e tradizionale e verificare gli effetti sul lungo termine.

Injury to the central nervous system as a result of cerebrovascular accidents (CVA) often leads to impairment in balance and mobility. Very little is known about the strategies that patients with CVA employ to prevent falls during unexpected changes of a support surface while patients are standing and walking. Previous studies showed that light touch increases postural stability in healthy subjects. However, it is not known whether patients with CVA would benefit from light touch in the same way as the healthy subjects do. Three studies in this research were conducted to examine the impact of stroke on postural responses triggered by surface rotations (Triggered Postural Responses; TPRs) during standing and walking and to investigate the effect of light touch on the control of TPRs during both tasks. Pitch and roll surface rotations (amplitude:5o; peak velocity:32o/s) were randomly presented to 11 stroke and 8 healthy age-matched subjects during quiet stance and walking, with similar limb geometry in double limb support. Light touch (<4N) was provided by a load sensor strip mounted on a rail along the walkway. Body kinematics was captured at 120 Hz by a 6-camera Vicon 512 system. Ground reaction forces were acquired at 1080Hz by 2 AMTI force plates. Surface EMGs were recorded at 1080 Hz from 4 bilateral lower limb muscles. Results showed that TPRs in healthy subjects were functionally appropriate to the direction of perturbations and task demands, such that TPRs were tuned down during walking, as compared to standing, suggesting that postural requirements are less during walking. In contrast, CVA disrupts equilibrium control such that TPRs in the stroke subjects were delayed and not modulated as the perturbed directions and task demands changed, possibly due to problems in sensorimotor integration. Asymmetry was characterized by under-activated muscle responses and force generations of the paretic side and hyperactivity of the non-paretic upper and lower extremit
Les lésions du système nerveux central suite à un accident vasculaire cérébral (AVC) affectent fréquemment l'équilibre et la mobilité. Peu d'information est disponible sur les stratégies utilisées par les patients ayant survécu à un AVC pour prévenir les chutes lorsque des changements inattendus de la surface de support se produisent pendant la marche et la position debout. Des études ont établi que des sujets sains voient leur stabilité posturale améliorée avec l'ajout d'information tactile. Cependant, il n'a pas été démontré si les sujets ayant eu un AVC peuvent aussi bénéficier de ces informations tactiles. Cette recherche inclut trois études visant à examiner, en premier lieu, l'impact d'un AVC sur les ajustements posturaux réactifs (APR) déclenchés par des rotations de la surface de support et, en deuxième lieu, l'effet des informations tactiles sur le contrôle de ces APR pendant deux tâches, soit la marche et la position debout. Onze sujets ayant eu un AVC et huit sujets sains, appariés pour le genre et l'âge, ont participé à ces études. Des rotations de la surface de support dans les plans sagittal et frontal (amplitude: 5°; vélocité maximale: 32°/s) étaient présentées aléatoirement aux sujets lors de la marche (phase de double appui) et en position debout (position des membres inférieurs simulant la phase de double appui). Le toucher léger (< 4N) d'une rampe fournissait l'information tactile aux sujets. Un système à six caméras d'analyse tridimensionnelle du mouvement (Vicon 512 system) a été utilisé pour acquérir les données cinématiques du corps à une fréquence de 120 Hz. L'électromyographie de surface de quatre muscles du membre inférieur a été enregistrée bilatéralement à une fréquence de 1080 Hz. Les forces de réaction du sol ont été acquises par deux plate-formes de force (AMTI) à la même fréquence. Les sujets sains ont présenté des APR fonctionnels et modulés par la directio

[Truncared abstract] Introduction: The assessment of any therapy requires not only an understanding of how that therapy works but also how it affects health related quality of life (HRQOL). Botulinum Toxin A(BoNT-A) therapy for upper limb spasticity management in children with hemiplegic cerebral palsy(CP) is currently under trial. Despite its use for over a decade for lower limb spasticity, little is known about the mechanisms involved in improving motor function and the effect on the child and their familys HRQOL. Both central and peripheral mechanisms are hypothesised[1]. Whilst evidence of improved quality of movement and ability to perform tasks is emerging[2-4], this cannot be directly correlated with an improvement in HRQOL. In addition, the traditional method of assessing child HRQOL by parent proxy reports has come under question[5, 6]. The World Health Organisation now recommends the collection of both parent proxy and child self-reports[7]. Aims: 1. Investigate the corticomotor projections to the upper limb in school aged children with hemiplegic CP and the changes that occur with BoNT-A therapy by transcranial magnetic stimulation (TMS). 2. Investigate the effect of upper limb BoNT-A therapy on HRQOL of school aged children with hemiplegic CP by completion of the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 3. Determine the concordance between Child Self-Report and Parent Proxy Report scores for the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 4. Determine the concordance between PedsQL scores and function as assessed by the Melbourne Assessment of Unilateral Upper Limb Function (MUUL). Methods: Design: Prospective randomised pilot study. Setting: Department of Paediatric Rehabilitation, Princess Margaret Hospital, and Centre for Neurological and Neuromuscular Disorders, Perth. Participants: 22 school aged children with hemiplegic CP aged 7yr 0mth-13yr 11mth (12 treatment, 10 control). 3 Treatment: One episode BoNT-A injections (dose 1-2U/kg/muscle) into the upper limb for treatment group. The control group received usual care. ... Conclusion: This pilot study provides preliminary evidence of the effects of upper limb BoNT-A therapy at both a central physiological and a broader quality of life level in school aged children with hemiplegic CP. At a central level, corticomotor pathway reorganisation occurs in the setting of BoNT-A. However the reorganisation is not limited to the affected side pathways suggesting a systemic BoNT-A effect or developmental changes. Similarly, in this pilot study, there was no statistically significant effect of upper limb BoNT-A on the childs HRQOL as assessed by the PedsQL although positive trends were observed 4 for a number of physical and psychosocial domains. The collection of both child self-report and parent proxy reports when assessing HRQOL is recommended, and function needs to be assessed independently. Larger studies across the broader CP population, the design of CP specific HRQOL tools appropriate for use in the higher functioning CP cohort, and alternative better tolerated methods of investigating the motor system in children with movement disorders are recommended.

Thesis (MScPhysio)--Stellenbosch University, 2012
ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

Orientador: Aparecido Augusto de Carvalho
Banca: Antônio de Pádua Lima Filho
Banca: Augusto Cesinando de Carvalho
Resumo: Neste trabalho descreve-se um sistema constituído por duas plataformas de forças e seus respectivos circuitos de condicionamento e interfaceamento de sinais, projetado para medir a distribuição de descarga de peso na região plantar de pacientes. Em cada plataforma de força foram acopladas 24 células de carga construídas com extensômetros. As características estáticas do sistema foram determinadas em laboratório utilizando pesos conhecidos. O sistema apresentou linearidade, com coeficiente de determinação de 0,9997, baixa histerese, precisão de 0,84% e resolução de 0,5 N. As medidas são apresentadas na tela de um computador facilitando a visualização para especialistas da área, principalmente médicos, fisioterapeutas e terapeutas ocupacionais. Utilizando o sistema foram medidas as distribuições de peso na região plantar de 87 indivíduos sem hemiplegia (sem histórico de queixas de dores ou problemas no sistema neuromusculoesquelético) e de 10 hemiplégicos crônicos, com mais de um ano de hemiplegia. Estes foram submetidos à avaliação utilizando a Escala de Equilíbrio de Berg. Entre os indivíduos se hemiplegia, estudou-se mais detalhadamente um grupo de 15 bailarinos e um de 12 ginastas rítmicas. Determinou-se a relação entre a distribuição de pesos nos antepés esquerdo e direito de indivíduos sem hemiplegia e hemiplégicos com o sistema implementado. Através do sistema constatou-se que a relação entre a distribuição de pesos no antepé esquerdo e direito dos indivíduos hemiplégicos é muito mais elevada que a dos indivíduos sem hemiplegia. Este resultado era de se esperar, uma vez que o hemiplégico descarrega seu peso predominantemente no lado não plégico
Abstract: This work describes a system consisting of two force platforms and their conditioning circuits and interfacing signals, designed to measure the distribution of weight load on the plantar region of patients. Each force platform was constructed with 24 load cells with strain gages. The static characteristics of the system were determined in laboratory using known weights. The system showed linearity with determination coefficient of 0.9997, low hysteresis, accuracy of 0.84% and resolution of 0.5 N. The measurements are presented in a computer screen in a friend way for specialists in the health field, mainly doctors, physiotherapists and occupational therapists. Using the system we measured the weight distributions in the plantar region of 87 normal patients (no history of complaints of pain or problems in the neuromuscular system) and 10 hemiplegic, with more than a year of hemiplegia. The latter were evaluated using the Berg Balance Scale. Among normal subjects, we studied a further group of 15 dancers and one of 12 rhythmic gymnasts. The relationship between the distribution of weights in the left and right forefeet of patients with normal and hemiplegic was determined with the implemented system. Through the system we found that the relationship between weight distribution on the left and right forefoot of hemiplegic patients is much higher than that of normal patients. This result was expected, since the hemiplegic unloads his weight predominantly in non-paralyzed side
Mestre

La restauration fonctionnelle du membre supérieur chez l'hémiplégique séquellaire reste toujours l'objectif primordial recherché durant le processus de réhabilitation. De nos jours, les techniques émergentes de rééducation montrent de plus en plus d'efficacité et de réalisme, si elles sont accompagnées par les techniques conventionnelles et classiques. De plus, quelques idées anciennes ont évoluées vers l'utilisation du renforcement musculaire du membre atteint afin d'améliorer sa fonction motrice. En effet, le renforcement musculaire isocinétique constitue une technique potentiellement intéressante de rééducation pour des hémiplégiques. Dans le cadre de notre travail doctoral, nous avons utilisé le concept isocinétique pour réhabiliter les déficits moteurs et diagnostiquer les déficits de coordination du membre supérieur hémiplégique. En premier lieu, nous avons essayé de montrer le rôle de l'isocinétisme pour optimiser la prise en charge du membre supérieur chez l'hémiplégique. Nous avons d'abord présenté une revue de littérature sur le renforcement musculaire isocinétique après hémiplégie suite à une lésion cérébrale. Ensuite, nous avons évalué la faisabilité d'un programme basé sur ce type de renforcement, pour le coude et le poignet chez des hémiparétiques. Ainsi, l'utilité et l'efficacité de ce type de réentraînement isocinétique ont pu être mises en évidence. En second lieu, nous avons utilisé l'isocinétisme pour comprendre l'implication du rôle des afférences dans le déficit de coordination bimanuelle après accident vasculaire cérébral causant une hémiplégie. Dans l'ensemble, ces différents résultats autorisent à recommander l'outil isocinétique pour quantifier les déficits moteur et de coordination du membre supérieur chez l'hémiplégique, en vue d'une meilleure élaboration et mise en place de protocoles de rééducation isocinétique
Functional restoration of the upper limb in sequelae hemiplegic remains the primary objective during the rehabilitation process. Nowadays, emerging rehabilitation techniques show more efficiency and realism, if they are accompanied by conventional and standard techniques. In addition, some old ideas have evolved to use the affected limb muscle strengthening to improve motor function. Indeed, the isokinetic muscle strengthening is a potentially interesting technique for rehabilitation of hemiplegic patients. As part of our doctoral work, we used the isokinetic concept to rehabilitate motor deficits and diagnose coordination deficits for hemiplegic upper limb. First, we tried to show the role of isokinetic to optimize the management of upper limb in hemiplegic patients. We firstly presented a review of literature on isokinetic muscle strengthening after hemiplegia following a brain injury. Then, we evaluated the feasibility of a training program based on this type of reinforcement for the elbow and wrist in the hemiparetic patients. Thus, the usefulness and effectiveness of this type of isokinetic exercise training have been highlighted. Second, we used the isokinetic to understand the contribution of afference-based processes to the impairment of bimanual coordination after stroke causing hemiplegia. On the whole, these results allow recommending the isokinetic tool to quantify motor and coordination deficits of upper limb in hemiplegic patients, for better development and implementation of isokinetic rehabilitation protocols

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Neste trabalho descreve-se um sistema constituído por duas plataformas de forças e seus respectivos circuitos de condicionamento e interfaceamento de sinais, projetado para medir a distribuição de descarga de peso na região plantar de pacientes. Em cada plataforma de força foram acopladas 24 células de carga construídas com extensômetros. As características estáticas do sistema foram determinadas em laboratório utilizando pesos conhecidos. O sistema apresentou linearidade, com coeficiente de determinação de 0,9997, baixa histerese, precisão de 0,84% e resolução de 0,5 N. As medidas são apresentadas na tela de um computador facilitando a visualização para especialistas da área, principalmente médicos, fisioterapeutas e terapeutas ocupacionais. Utilizando o sistema foram medidas as distribuições de peso na região plantar de 87 indivíduos sem hemiplegia (sem histórico de queixas de dores ou problemas no sistema neuromusculoesquelético) e de 10 hemiplégicos crônicos, com mais de um ano de hemiplegia. Estes foram submetidos à avaliação utilizando a Escala de Equilíbrio de Berg. Entre os indivíduos se hemiplegia, estudou-se mais detalhadamente um grupo de 15 bailarinos e um de 12 ginastas rítmicas. Determinou-se a relação entre a distribuição de pesos nos antepés esquerdo e direito de indivíduos sem hemiplegia e hemiplégicos com o sistema implementado. Através do sistema constatou-se que a relação entre a distribuição de pesos no antepé esquerdo e direito dos indivíduos hemiplégicos é muito mais elevada que a dos indivíduos sem hemiplegia. Este resultado era de se esperar, uma vez que o hemiplégico descarrega seu peso predominantemente no lado não plégico
This work describes a system consisting of two force platforms and their conditioning circuits and interfacing signals, designed to measure the distribution of weight load on the plantar region of patients. Each force platform was constructed with 24 load cells with strain gages. The static characteristics of the system were determined in laboratory using known weights. The system showed linearity with determination coefficient of 0.9997, low hysteresis, accuracy of 0.84% and resolution of 0.5 N. The measurements are presented in a computer screen in a friend way for specialists in the health field, mainly doctors, physiotherapists and occupational therapists. Using the system we measured the weight distributions in the plantar region of 87 normal patients (no history of complaints of pain or problems in the neuromuscular system) and 10 hemiplegic, with more than a year of hemiplegia. The latter were evaluated using the Berg Balance Scale. Among normal subjects, we studied a further group of 15 dancers and one of 12 rhythmic gymnasts. The relationship between the distribution of weights in the left and right forefeet of patients with normal and hemiplegic was determined with the implemented system. Through the system we found that the relationship between weight distribution on the left and right forefoot of hemiplegic patients is much higher than that of normal patients. This result was expected, since the hemiplegic unloads his weight predominantly in non-paralyzed side

碩士
中國醫藥大學
中西醫結合研究所
96
This is a retrospective study to assess the effect of acupuncture in the functional outcome of patients with stroke.All the participants were patients of first stroke with Brunnstrom’s stage: I-V. They received either comprehensive rehabilitation combined acupuncture or comprehensive rehabilitation alone .The functional status of all stroke patients was evaluated with functional independent measure and Barthal index during and admission and discharge from the rehabilitation unit according to Functional assessment and Barthal Index. Acupuncture was administered five times per weekly comprehension rehabilitation program included phtsical therapy,occupational therapy,speech therapys of various combination according to the patient is clinical status.

Indiana University-Purdue University Indianapolis (IUPUI)
Background: Rehabilitation Robotics (RR) has become a more widely used and better understood treatment intervention and research tool in the last 15 years. Traditional research involves pre and post-test outcomes, making it difficult to analyze changes in behavior during the treatment process. Harnessing kinematics captured throughout each treatment allows motor learning to be quantified and questions of application and dosing to be answered. Objective: The aims of this secondary analysis were: (i) to investigate the impact of treatment presentation during RR on upper extremity movement time (mt) in children with hemiplegic cerebral palsy (CP) and (ii) to investigate the impact of training structure (dose and intensity) on mt in children with CP participating in RR. Methods: Subjects completed 16 intervention sessions of RR (2 x week; 8 weeks) with a total of 1,024 repetitions of movement per session and three assessments: pre, post and 6 month f/u. During each assessment and intervention, subjects completed “one-way record” assessments tracking performance on a planar task without robotic assistance. Kinematics from these records were extracted to assess subject performance over the course of and within sessions. Results: For all participants, a significant decrease in mt was found at post-test and follow-up. No significant differences were found in mt for age, severity or group placement. A significant interaction was found between treatment day, block and group (p = .033). Significant mt differences were found between the three blocks of intervention within individual days (p = .001). Specifically, significant differences were found over the last block of treatment (p = .032) and between successive treatment days (p = .001). Conclusion: The results indicate that for children with CP participating in RR, the number of repetitions per session is important. We hypothesized that children’s performance would plateau during a treatment day as attention waned, the opposite proved to be true. Despite the high-number of repetitions and associated cognitive demand, subjects’ performance actually trended upwards throughout the 1,024 repetitions suggesting that children were able to tolerate and learn from a high volume of repetitions.

Young children with HCP experience difficulties performing age-appropriate daily activities such as self-care and play. Research in neuroplasticity has shown that intensive, task-specific training in early development is ideal to maximize functioning in children with HCP. The aim of this study was to analyze the feasibility of a new manualized clinical guideline, Family Activity Adaptation Model (FAAM), via Telehealth to coach families to develop daily activities and routines that facilitate functional bimanual skills in young children with hemiplegic cerebral palsy (HCP). Ten caregivers and children with HCP (3-7 years) received virtual training on how to embed bimanual intensive training (HABIT) into their everyday activities and routines on their own at home for 90 minutes a day, 5 days a week over 8 weeks. Caregivers and children received virtual coaching using the FAAM method 2 times per week. FAAM Activity Analysis was used to describe manual development. Daily activity logs were used to assess family adherence and home program feasibility. Bimanual functional goal performance and satisfaction was measured using the Canadian Occupational Performance Measure (COPM). Perceived changes in overall bimanual functional skills were evaluated using the Mini-Children’s Hand Use Experience Questionnaire (Mini-CHEQ). Caregiver stress, burden and program satisfaction was monitored using the Parenting Stress Index (PSI-4-SF), the Ease of Caregiving for Children measure and a caregiver satisfaction survey. The measures were assessed immediately prior to (pretest), midpoint (burden measures only, repeated measures ANOVA) and immediately after (posttest, Wilcoxon Sign Rank Test) the intervention. All families made statistically and clinically significant improvements in goal performance (p=.008) satisfaction (p=.007), and overall bimanual hand use (p=.035). All families completed daily logs and practiced strategies for an average of 81.37 (SD=7.069) minutes a day. Caregiver burden and stress remained consistent throughout the study and all caregivers reported satisfaction with the program. This is the first study to manualize a family centered, telehealth-delivered intensive motor training program. This study adds a continuum of care and access to services for children and families with limited resources. The study supports clinicians with home program design and meets the individual needs of families using resources in their natural environment.